I wish I had a dime for each time a guilt ridden parent of a child with severe scoliosis told me, “we would have do something if we only knew sooner”.  I can only imagine the sickening feeling that hits them in the gut when the orthopedic scoliosis specialist puts that full spine scoliosis x-ray up and says “we do scoliosis surgery on Tuesdays and Thursdays.”  This is the all too familiar story I here on a weekly basis and I’m not exaggerating, a weekly basis.

So what is the problem in mild scoliosis detection?  Why to so many children slip through the cracks during scoliosis screenings only to end up sitting in an orthopedic surgeons office with a severe scoliosis spine deformity and being prepared for a highly invasive scoliosis surgery that even in its most successful cases has an unacceptably high rate of long-term complications.

The most widely known and used scoliosis screening test is called “Adam’s positions” and it has been around for a long, long, long time.  Basically the patient bends forward at the waist and the examiner stands behind the patient looking for one side of the rib cage to bulge higher than the other (typically the right side).  Generally, the bulging isn’t readily detectable until the spinal curvature is at least moderately advanced, because of the pathological thoracic rotation pattern that begins to develop as the curve progresses towards the 30 degree level, which causes the rib cage rotation to be visible.  It is for this reason; many of the experienced professionals in scoliosis treatment refer to Adam’s positions as “the too late test”.

Posture evaluation may be the ideal system of detecting early stage scoliosis and replacing the “too late test”.  Mild scoliosis will begin creating asymmetrical and distorted posture patterns long before the rib cage rotation becomes visible, even in the Adam’s positions and is so readily identified that untrained individuals can pick up on abnormal findings with little to no training.

Everyone knows that a child’s eye line, shoulder level, and hips should appear level when viewed from the front or back, but most parents, gym teachers, dance instructors, or swim coaches don’t equate an un-leveling of these key postural markers to anything serious or even think to mention anything about it.  This is often the first missed opportunity for early stage scoliosis intervention of many that could prevent a child from having to undergo a highly invasive and controversial scoliosis surgery later in life.

It is as though we need to start some sort of “see something, say something” type campaign for mild scoliosis screenings and get the word out to parents, school nurses, and healthcare professionals alike that postural evaluation for scoliosis screens should be utilized in conjunction with the Adam’s positions, and potentially even replace them in the future.  However, the best scoliosis screening procedures in the world, won’t make any difference if the mild scoliosis cases are instructed to “watch and wait” for 6 month increments, until the curve progresses to a moderate or severe level.  Only when coupled with an early stage scoliosis intervention program will effective mild scoliosis screening programs truly benefit the scoliosis community as a whole.